MEDICARE: ZICHANG PAN DDS & SHUYUN ZENG DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	46417	CA
2	122300000X	Dentist	46717	CA

General Provider Information

NPI Number	:	1548241417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZICHANG PAN DDS & SHUYUN ZENG DDS INC

Provider Business Mailing Address
First Line	:	39560 STEVENSON PL
Second Line	:	SUITE 220
City	:	FREMONT
State	:	CA
Zip	:	94539-3074
Country	:	US
Telephone Number	:	510-818-0182
Fax Number	:	510-818-0313

Provider Business Practice Location Address
First Line	:	39560 STEVENSON PL
Second Line	:	SUITE 220
City	:	FREMONT
State	:	CA
Zip	:	94539-3074
Country	:	US
Telephone Number	:	510-818-0182
Fax Number	:	510-818-0313

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SHUYUN ZENG
Credential	:	DDS
Telephone Number	:	510-818-0182

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	08/22/2020

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